The aim of this study is to determine the accuracy of adrenal vein sampling (AVS) with and without
adrenocorticotropic hormone (
ACTH) stimulation to distinguish between unilateral and bilateral
primary hyperaldosteronism (PA). Retrospective analysis of a prospective database from a referral center between 1984 and 2009, 76 patients had simultaneous cannulation of bilateral adrenal veins and AVS with and without
ACTH stimulation. All patients had
adrenalectomies. The selectivity index (SI, cut-off value ≥2) was used for confirmation of successful cannulation of the adrenal vein. The lateralization index (LI, cut-off value >2 and >4) was used for distinguishing between unilateral and bilateral PA. The SI ratio was higher with
ACTH stimulation compared to without for the right adrenal vein (p = 0.027). The LI >2 ratio was higher with
ACTH stimulation compared to without (p = 0.007). For the LI >4 ratio, there was no difference between with and without
ACTH stimulation (p = 0.239). However, for a LI >4, 7 patients (9.2%) were not lateralized with
ACTH stimulation, but they did lateralize without
ACTH stimulation. AVS with
ACTH stimulation is associated with a higher SI ratio compared to AVS without
ACTH stimulation. However, when using LI >4 for AVS, samples without
ACTH stimulation should also be included to detect a subset of patients with unilateral disease that are not detected with
ACTH stimulation.